Supplementary Material for: Treating PTSD: the complexities of the clinical realm

In the immediate aftermath of his fiancée’s tragic bolus death (sudden cardiac arrest after a piece of cheeseburger had gotten stuck in her throat), John had developed acute stress disorder. In spite of early psychological intervention, he went on to develop posttraumatic stress disorder (PTSD) plus a comorbid depressive episode. When offered trauma-focused cognitive-behavioral therapy (tf-CBT), John refused to engage in exposure treatment. Instead, we started working on his dysfunctional interpretations and related guilt feelings (“If only I was a doctor, I could have rescued her!”; “If we had not argued over the problem with the door keys, she wouldn’t have been so stressed out, and thus would not have gagged on the burger bite!”). After ten sessions of Socratic dialogue and cognitive restructuring, John had achieved a more realistic view regarding his responsibility in the events that had led to his fiancée’s passing away three months previously. His negative alterations in cognition and mood as well as his hyperarousal and depressive symptoms had decreased substantially. However, he still suffered from nightmares and flashbacks. After three additional sessions of “self-invented” exposure, namely listening to the audio recording of his phone calls to the rescue service’s receptionist on the day of his fiancée’s death, his intrusions abated.